Biomechanical comparison between single-row with triple-loaded suture anchor and suture-bridge double-row rotator cuff repair

Abstract

Background Numerous biomechanical and clinical studies comparing different techniques for rotator cuff repair have been reported, yet universal consensus regarding the superior technique has not achieved. A medially-based single-row with triple-loaded suture anchor (also referred to as the Southern California Orthopedic Institute [SCOI] row) and a suture-bridge double-row (SB-DR) with Push-Locks have been shown to result in comparable improvement in treating rotator cuff tear, yet the biomechanical difference is unknown. The purpose of the current study was to determine whether a SCOI row repair had comparable initial biomechanical properties to a SB-DR repair. Methods Six matched pairs of fresh-frozen cadaveric shoulders with full-thickness supraspinatus tendon tears we created were included. Two different repairs were performed for each pair (SCOI row and SB-DR methods). Specimens were mounted on a material testing machine to undergo cyclic loading, which was cycled from 10 to 100 N at 1 Hz for 500 cycles. Construct gap formation was recorded at an interval of 50 cycles. Samples were then loaded to failure and modes of failure were recorded. Repeated-measures analysis of variance and pair-t test were used for statistical analyses. Results The construct gap formation did not differ between SCOI row and SB-DR repairs (P = 0.056). The last gap displacement was 1.93 ± 0.37 mm for SCOI row repair, and 1.49 ± 0.55 mm for SB-DR repair. The tensile load for 5 mm of elongation and ultimate failure were higher for SCOI row repair compared to SB-DR repair (P = 0.011 and 0.028, respectively). The ultimate failure load was 326.34 ± 11.52 N in the SCOI row group, and 299.82 ± 27.27 N in the SB-DR group. Rotator cuff repair with the SCOI row method failed primarily at the suture- tendon interface, whereas pullout of the lateral row anchors was the primary mechanism of failure for repair with the SB-DR method. Conclusion Rotator cuff repair with the SCOI row method has superior biomechanical properties when compared with the SB-DR method. Therefore, SCOI row repair using a medially-based single-row technique with triple-loaded suture anchor is recommended to improve the initial strength in treating full-thickness rotator cuff tears.

A case report of re-implanting a neglected avulsion of supraspinatus tendon by arthroscopic and open surgeries

“…A more recent biomechanical study of six fresh-frozen cadaveric shoulders compared single-row with triple-loaded suture anchors with suture-bridge double-row repairs for full thickness supraspinatus tears. Superior biomechanical properties were found in the single-row group, with this group exhibiting higher ultimate failure loads (326 N vs 300 N) [23] . A recently published review reported a progression rate of 40% in conservatively treated full-thickness tears after 4 years' observation [24] .…”

The “Greenhouse” Technique Using Knotless Single-Row Suture Bridge Combined With Bone Marrow Stimulation for the Arthroscopic Treatment of Rotator Cuff Tears

“…The goals of rotator cuff repair are to reduce pain and to restore shoulder function, which require anatomic footprint restoration with minimum gap formation, broad tendon-to-bone contact area, and biological stimulation to promote tendonebone healing. [1][2][3][4] Theoretically, the standard suture bridge has many advantages over single-and double-row repair. [5][6][7] Clinically, the rotator cuff cannot be adequately mobilized and anatomic bone-to-tendon repair would be difficult because of excessive tension.…”

“…Suture-bridge repair was introduced by using 2 rows of anchors to improve tendon-to-bone contact over the footprint, together with decreased motion on the boneetendon interface and increased resistance to rotational forces. [1][2][3][4] Although this technique leads to several advantages over the standard single-row or doublerow repair, the incidence of retear cannot be avoided. [4][5][6][7] The most possible explanations may include greater tension for the repaired tendon than expected; tendon strangulation caused by medial row knottying; and further damage to the degenerated torn tendon.…”

Tendon‐to‐bone healing after repairing full‐thickness rotator cuff tear with a triple‐loaded single‐row method in young patients

“…Another study conducted by Mazzocca et al [ 31 ] confirmed that the single-row repair technique was similar to the double-row techniques in load-to-failure, cyclic displacement, and gap formation, which was attributed to a larger number of suture passes through the tendon. He et al [ 33 ] reported that rotator cuff repair using the SCOI row method has superior biomechanical properties when compared with the double-row method. Indeed, our results support this view.…”